Gonorrhea (also colloquially known as the clap) is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain. In both men and women if gonorrhea is left untreated, it may spread locally causing epididymitis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves.
Treatment is commonly with ceftriaxone as antibiotic resistance has developed to many previously used medications.
In 2011, there were reports of some strains of gonorrhea showing resistance to ceftriaxone.
Signs and symptoms
Half of women with gonorrhea are asymptomatic while others have vaginal discharge, lower abdominal pain or pain with intercourse. Most men who are infected have symptoms such as urethritis associated with burning with urination and discharge from the penis.
The incubation period is 2 to 30 days with most symptoms occurring between 4–6 days after being infected.
Cause
Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. The infection is transmitted from one person to another through vaginal, oral, or anal sex. Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men who have sex with men is higher. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum. It cannot be spread by toilets or bathrooms.
Diagnosis
Traditionally, gonorrhea was diagnosed with gram stain and culture; however, newer polymerase chain reaction (PCR) based testing methods are becoming more common. In those who fail initial treatment culture should be done to determine sensitivity to antibiotics. All people who test positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia, syphilis and human immunodeficiency virus.
Screening
The United States Preventive Services Task Force recommends screening for gonorrhea in women at increased risk of infection which includes all sexually active women younger than 25 years. It is not recommended in males without symptoms or low risk women.
Prevention
While the only sure way of preventing gonorrhea is abstaining from sexual intercourse, the risk of infection can be reduced significantly by using condoms correctly and by having a mutually monogamous relationship with an uninfected person.
Treatment
Gonorrhea if left untreated may last for weeks or months with higher risks of complications. As of 2010 injectable ceftriaxone appears to be one of the few effective antibiotics. Because of increasing rates of antibiotic resistance local susceptibility patterns need to be taken into account when deciding on treatment. Many antibiotics that were once effective including penicillin, tetracycline and fluoroquinolones are no longer recommended because of high rates of resistance. Cases of resistance to ceftriaxone have been reported but are still rare.
In 2011, there have been reports of a "Superbug" gonorrhea which is antibiotic resistant, specifically that this new strain is resistant to both cefixime (oral medication) and ceftriaxone (intravenous).
Partners
It is recommended that sexual partners be tested and potentially treated. One option for treating sexual partners of people infected is patient-delivered partner therapy (PDPT) which involves providing prescriptions or medications to the person to take to their partner without the health care provider first examining them.
Complications
One of the complication of gonorrhea is systemic dissemination resulting in skin pustules or petechia, septic arthritis, meningitis or endocarditis.This occurs in between 0.6 and 3.0% of women and 0.4 and 0.7% of men.
In men, inflammation of the epididymis (epididymitis); prostate gland (prostatitis) and urethral stricture (urethritis) can result from untreated gonorrhea. In women, the most common result of untreated gonorrhea is pelvic inflammatory disease. Other complications include perihepatitis, a rare complication associated with Fitz-Hugh-Curtis syndrome; septic arthritis in the fingers, wrists, toes, and ankles; septic abortion; chorioamnionitis during pregnancy; neonatal or adult blindness from conjunctivitis; and infertility.
Neonates coming through the birth canal are given erythromycin ointment in the eyes to prevent blindness from infection. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
Among persons in the United States between 14 and 39 years of age, 46% of people with gonorrheal infection also have chlamydial infection.
Epidemiology
Gonorrhea is a common infectious disease. In the United Kingdom 196 per 100,000 males 20 to 24 years old, and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005. The CDC estimates that more than 700,000 people in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons.
In the US, it is the second most common bacterial sexually transmitted infections after chlamydia.
History
It has been suggested that mercury was used as a treatment for gonorrhea. Surgeons' tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.
Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver, which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.
The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occur in the Acts of the (English) Parliament. In 1161 this body passed a law to reduce the spread of "...the perilous infirmity of burning." The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre by Crusaders.
Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health doctors to treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.
Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.